Las Vegas Hospital Led by HPM Alum Manages Deluge of Patients After October 1 Shooting

Ryan Jensen, chief executive officer for Desert Springs Hospital Medical Center is typically a very early riser.  He was already asleep at 10 pm on the evening of October 1 when he was awakened by the insistent buzzing of his phone.  That was the last sleep he got until midnight of the following night, when he had been awake for nearly 40 hours.  During that time, Jensen, an alumnus of the George Washington University Milken Institute School of Public Health’s MHA program, and his colleagues at the hospital proved just how capable they are by responding to a tragedy that no one could have predicted or planned for.

Desert Springs Hospital Medical Center is a 293-bed acute care hospital that provides many services including open heart surgery and orthopedic surgery.  “We’re capable of taking care of some traumatic injuries, but we are not a designated trauma center,” Jensen says.  After he heard that a shooting had taken place from his administrator on-call, Jensen turned on his TV and saw the first local news reports of the shooting.  Those reports mentioned two dead and 20 wounded, and Jensen didn’t expect many trauma cases to arrive at his hospital because the policy of Emergency Medical Services (EMS) and ambulances is to transport victims with traumatic injuries to the local trauma centers.  But he felt he should go in anyway. 

As he and his colleagues at the hospital soon learned, the friends and other heroic citizens who stepped up to help people injured in the mass shooting at the country music festival were just looking for the closest medical facility. 

The Desert Springs Hospital Medical Center is one of the closest hospitals to the Las Vegas Strip where the shooting took place.  The non-medical first responders who transported the injured there—including a bus driver who brought in 25 victims—found the hospital using the GPSs on their phones, Jensen explains. 

Jensen lives about 30 minutes away from the hospital.  While en route, he learned from his chief of staff, an emergency medicine physician, that the hospital was already treating more than 60 patients with gunshot wounds and four more had been dead on arrival.

When Jensen arrived at the Desert Springs Hospital Medical Center, he entered the building as he always does by passing the gastrointestinal endoscopy suite area.  It would normally be set up for the next morning’s surgeries and empty at that time of night, but it was completely full of patients because the emergency room (ER) was also full.  A makeshift morgue had been established nearby for the victims who were dead on arrival.  “The gravity of the situation hit me very quickly,” Jensen recalls. 

Almost like a military MASH unit

“I had never before seen the ER the way it was that night.  It was almost like a military MASH unit,” Jensen says.  “There were so many people, we ran out of space.”  He said he had plenty of help because many of the hospital’s employees decided to come in to assist in any capacity once the scale of the shooting became apparent.  Over 30 of the hospital’s physicians, surgeons, and mid-level providers, including nurse practitioners and physician assistants, ended up coming in that night.  “They just saw what was happening on the news,” he says, “and came in.”

Because critically injured patients were being transported into the hospital through its front door, not the back door near the ER, the hospital set up a mobile incident command.  “Our command center is on the other side of the hospital, and it did not make any sense for us to be over there when everything was happening in our Emergency Department.  We never practiced moving our command center in our disaster drills, but it just made sense to set up a mobile incident command center in the emergency department (ED) break room ,” Jensen says.

During the evening, the hospital officially treated 93 victims, but actually saw dozens more.  The facility’s director of Emergency Preparedness Management was one of the first leaders to arrive and acted as the incident commander.  The hospital’s chief of staff, who is also an ED physician, assessed the condition of each new patient and directed their care appropriately.  The two medical professionals handled the situation so effectively that Jensen was able to spend his time working with law enforcement, consoling grieving families, and helping out anywhere else he was needed. 

In those hours immediately following the shooting, Jensen explains, no information was yet available about the shooter, so the metropolitan police had surrounded Desert Springs Hospital Medical Center and other area hospitals.  “This gave us peace of mind to keep working through all of this,” he says. 

After the designated trauma centers filled up with patients, EMS dispatchers also began sending patients to Desert Springs Hospital.  “I don’t think they realized that we had civilians bringing in people,” Jensen said.  At that point, the hospital’s operating facilities were full.  The chief of staff assessed the condition of additional patients brought to the hospital.  Any needed life-saving care was provided in the ambulance and the patient would be sent to another facility that had capacity to care for them. 

A patient who knew gun shots when he heard them

Of the 93 patients officially treated at the hospital, 20 were admitted and 11 were in critical condition.  “Of those who arrived alive at the hospital, none passed away,” Jensen says.  One of the victims treated at the hospital was Curtis Leoni, a police officer from Colorado who was attending the concert where the shooting took place.  Although Leoni had never before been shot at—much less hit—during his 22 years as an officer, he knew gun shots when he heard them.  He told his girlfriend, Robin Davis, who was attending the show with him, to crouch down and he shielded her. He was shot once in the arm and twice in the leg.  Although he was lucky in that none of his vital organs were harmed, Leoni’s leg was injured so badly that he couldn't move and Davis got shrapnel in her leg. 

According to a news report, other concert-goers that Leoni refers to as “good Samaritans” helped to move him to a barricade.  At this time, he said, no one really knew where the shooter was, or even whether he was firing from outside or was somewhere in the crowd.  Davis took the strap from her purse and used it as a tourniquet on Leoni.  Later, some men used one of the metal barricades as a gurney and carried Leoni to the exit, with one of the men using his belt as a second tourniquet on Leoni.  Eventually Leoni and Davis were transported to Desert Springs Hospital Medical Center.

“We do disaster drills and training, but this was completely different,” Jensen says.  A scenario drill might have the facility plan to treat 10 to 15 people injured in a plane crash at the airport.  The patients would have a variety of injuries and would be delivered via EMS, which would alert the facility 15 minutes in advance, giving everyone time to prepare.  “We didn’t have ambulance calls.  We just had people coming in through the front door,” Jensen says.

Jensen is proud of his organization for their teamwork, and the compassion and selflessness displayed by personnel at all levels. “Although this tragedy is something we soon hope to forget,” he says, “the events that day and in the weeks that followed have clearly unified our organization.”

A great foundation for decision-making

Jensen credits the health services management and leadership curriculum at GW’s MHA program for giving him a great foundation for decision-making.  His training gave Jensen and his fellow 2005 MHA alumni “the confidence to put the theory into practice in the real world,” he says, adding that “we play the way we practice.”  Jensen also notes that the wide array of backgrounds of the people he encountered at GW really helped him build his cultural competencies.  He thought back to those formative experiences as he dealt with many people from an array of different backgrounds after the October 1 shooting. 

Thanks in part to Jensen’s continuing ties to GW, his hospital is the place where a current MHA student, Nick Rizley, will be completing his administrative residency starting in July of 2018.  “We are developing training exercises based on our October 1 experiences that will benefit Nick and all of the MHA residents who may train with us in the future,” Jensen says. 

The many gifts of gratitude and admiration received by the hospital in the ensuing weeks after the October 1 shooting include a banner now in the EMS hallway that was signed by providers from Orlando Health, a medical center that took care of victims of the nightclub shooting there in June 2016. 

Jensen predicts that given the increasing incidence of mass shooting events, such scenarios are likely to be included more often in future disaster planning drills along with other likely calamities such as natural disasters like earthquakes and weather-related events.

A side effect that hospital leaders always need to consider and plan for are the mental health effects of living through such tragedies.  Jensen now knows that the most difficult time for providers can be months after tragic events, and he and other members of his leadership team have planned accordingly.  “It was a tough night for everybody; they were in action mode and got through.  We have planned and are continuing to plan for the time when our staff’s realization of what really occurred sinks in.  We’re getting through it,” he concludes.